Provider Demographics
NPI:1073140091
Name:GRANT, KATHLEEN H (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:H
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:C
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:
Practice Address - Street 1:2470 DANIELLS BRIDGE RD STE 231
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6188
Practice Address - Country:US
Practice Address - Phone:706-769-3362
Practice Address - Fax:706-769-5675
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00435207R00000X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program